Over-Diagnosis of UTI Syndromes in Emergency Department

A focus on antibiotic review in patients with an ED diagnosis of suspected UTI syndromes may support reductions in inappropriate antibiotic prescribing.

Patients with suspected urinary tract infection (UTI) syndromes may be unnecessarily prescribed antibiotics, according results of a study presented at the 29th European Congress of Clinical Microbiology & Infectious Diseases, held April 13-16, 2019, in Amsterdam, The Netherlands.

UTI syndromes are the one of the leading causes of visits to the emergency department (ED) and of hospital admissions, but it can be difficult to differentiate a UTI from other conditions with similar clinical presentation. As a result of concern for delaying antibiotic treatment for severe infections, physicians in the ED have a lower threshold for initiating empiric antibiotics in patients with suspected UTI syndromes. Many of these cases are later found to have a noninfectious cause, but antibiotics are often unnecessarily continued, which increases the risk for antimicrobial resistance. Therefore, this cohort study estimated the over-diagnosis of UTI syndromes frequency in the ED at a large teaching hospital in England to explore the potential to reduce antibiotic prescribing for patients with no evidence of bacterial infection.

Using data from electronic health records, a total of 943 patients with suspected UTI syndromes diagnosed in the ED and who submitted a urine sample for microbiologic culture were included in the study. Of these patients, 71% were admitted to the hospital. Clinical and demographic characteristics were recorded, and diagnoses made by the ED physician were compared with clinical diagnosis based on urinary symptoms, microbiologic outcomes, and International Classification of Diseases-10th edition (ICD-10) diagnostic codes. Consumption of antibiotics in these patients was then estimated.

Of the patients included, 289 had an ED diagnosis of UTI syndromes, which included cases of pyelonephritis (n=56), urosepsis (n=42), and lower UTI (n=191). Empiric antibiotic treatment was recorded for 91% of patients with lower UTI; however, 34.5% of these cases demonstrated clinical evidence of UTI. Further, 83 patients with a lower UTI that had available ICD-10 diagnostic codes were prescribed an average of 8.1 antibiotic defined daily doses for a median of 7.5 days; however 34 of these patients had a primary diagnostic code for a noninfectious condition.

Overall, the study authors concluded that, “A focus on antibiotic review in patients with an ED diagnosis of suspected UTI syndromes could support reductions in inappropriate antibiotic prescribing in secondary care.”